J Hematol

Journal of Hematology, ISSN 1927-1212 print, 1927-1220 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Hematol and Elmer Press Inc

Journal website http://www.thejh.org

Short Communication

Volume 8, Number 2, June 2019, pages 55-59

C-Reactive Protein Level: A Key Predictive Marker of Cachexia in Lymphoma and Myeloma Patients

Figure 1. Proportion (%) of the cachectic (n = 55) and the non-cachectic (n = 90) patients. Cachexia prevalence is represented by the score of weight loss severity (score of Martin): weight loss of severity 0 (n = 11), severity 1 (n = 17), severity 2 (n = 11), severity 3 (n = 13) and severity 4 (n = 3).

**Table 1.** Clinical and Biological Data at Diagnosis
	Cachexia cohort (n = 145)
*For all lymphomas. BMI: body mass index; CKD-EPI: chronic kidney disease epidemiology collaboration; CRP: C-reactive protein; FLIPI: follicular lymphoma international prognostic index; HL: Hodgkin lymphoma; IPI: international prognostic index for other lymphoma; IQR: interquartile range; ISS: international scoring system for multiple myeloma; NHL: non-Hodgkin lymphoma; MIPI: mantle cell international prognostic index; PCLI: plasma cell labeling index.
Age at diagnosis (years)	-	62.4 (48.0 - 70.9)	20.0 - 90.6
Male sex	89 (61)	-
Weigh at diagnosis (kg)	-	71.0 (60.0 - 82.0)	40.7 - 116.8
Height (cm)	-	170.0 (164.0 - 176.0)	145.0 - 197.0
BMI at diagnosis	-	24.3 (21.5 - 27.6)	16.2 - 39.4
Tobacco status
Never smoked	66 (45.5)	-
Old smoker	55 (38)	-
Actual smoker	24 (16.5)	-
Hemoglobin (g/L)	143 (99)	13.0 (11.5 - 14.1)	7.5 - 17.4
Total proteins (g/L)	122 (84)	71.5 (68.0 - 76.0)	38.0 - 106.0
Albumin (g/L)	122 (84)	40.2 (36.1 - 42.9)	17.1 - 48.6
CRP (mg/L)	114 (79)	5.0 (2.1 - 18.4)	0.3 - 245.7
Creatinine (µmol/L)	141 (97)	73.0 (60.0 - 86.0)	44.0 - 256.0
CKD-EPI (mL/min/1.73 m²)	140 (97)
< 60	19 (14)	-
> 120	16 (11)	-
60 - 120	100 (71)	62.4 (48.9 - 70.9)	20.0-90.6
Pathology
HL	28 (19)	-
NHL	86 (59)	-
Myeloma	31 (22)	-
Lymphoma
Ann Arbor stage* I-II	37/97	-
FLIPI < 2	8/13	-
MIPI < 3	3/6	-
IPI < 3	18/29	-
Myeloma
ISS index I	16/25	-
PCLI (%)	24	0.23 (0.10 - 0.61)
Ratio tumoral/normal plasmocytes	27	22.8 (6.4 - 49.0)

Table 1. Clinical and Biological Data at Diagnosis

Cachexia cohort (n = 145)

n (%)

Median (IQR)

Range

*For all lymphomas. BMI: body mass index; CKD-EPI: chronic kidney disease epidemiology collaboration; CRP: C-reactive protein; FLIPI: follicular lymphoma international prognostic index; HL: Hodgkin lymphoma; IPI: international prognostic index for other lymphoma; IQR: interquartile range; ISS: international scoring system for multiple myeloma; NHL: non-Hodgkin lymphoma; MIPI: mantle cell international prognostic index; PCLI: plasma cell labeling index.

Age at diagnosis (years)

62.4 (48.0 - 70.9)

20.0 - 90.6

Male sex

89 (61)

Weigh at diagnosis (kg)

71.0 (60.0 - 82.0)

40.7 - 116.8

Height (cm)

170.0 (164.0 - 176.0)

145.0 - 197.0

BMI at diagnosis

24.3 (21.5 - 27.6)

16.2 - 39.4

Tobacco status

Never smoked

66 (45.5)

Old smoker

55 (38)

Actual smoker

24 (16.5)

Hemoglobin (g/L)

143 (99)

13.0 (11.5 - 14.1)

7.5 - 17.4

Total proteins (g/L)

122 (84)

71.5 (68.0 - 76.0)

38.0 - 106.0

Albumin (g/L)

122 (84)

40.2 (36.1 - 42.9)

17.1 - 48.6

CRP (mg/L)

114 (79)

5.0 (2.1 - 18.4)

0.3 - 245.7

Creatinine (µmol/L)

141 (97)

73.0 (60.0 - 86.0)

44.0 - 256.0

CKD-EPI (mL/min/1.73 m²)

140 (97)

< 60

19 (14)

> 120

16 (11)

60 - 120

100 (71)

62.4 (48.9 - 70.9)

20.0-90.6

Pathology

28 (19)

NHL

86 (59)

Myeloma

31 (22)

Lymphoma

Ann Arbor stage* I-II

37/97

FLIPI < 2

8/13

MIPI < 3

3/6

IPI < 3

18/29

Myeloma

ISS index I

16/25

PCLI (%)

0.23 (0.10 - 0.61)

Ratio tumoral/normal plasmocytes

22.8 (6.4 - 49.0)

**Table 2.** Association Between Parameters Measured at Diagnosis and Cachexia During Treatment
	Original data	Bootstrap analysis (1,000 replicates)
*For all lymphomas. CI: confidence interval; CRP: C-reactive protein; DLBCL: diffuse large B-cell lymphoma; FLIPI: follicular lymphoma international prognostic index; IPI: international prognostic index for other lymphoma; ISS: international scoring system for multiple myeloma; HL: Hodgkin lymphoma; MIPI: mantle cell international prognostic index; NHL: non-Hodgkin lymphoma; OR: odds ratio; PCLI: plasma cell labeling index.
Total proteins > 72.5 g/L, n = 54/122	1.62 (0.77 - 3.47)	0.208	1.48 (1.38 - 1.58)
Albumin > 41.3 g/L, n = 43/122	1.21 (0.56 - 2.65)	0.635	1.39 (1.29 - 1.49)
CRP > 54.0 mg/L, n = 16/114	5.94 (1.55 - 39.14)	0.023	8.17 (3.44 - 19.41)
Hemoglobin > 12.0 g/L, n = 90/143	1.39 (0.69 - 2.79)	0.353	1.14 (1.03 - 1.27)
Creatinine > 93.5 µmol/L, n = 26/141	0.30 (0.12 - 0.73)	0.009	0.78 (0.64 - 0.96)
Pathology
HL, n = 30	Ref		NA
NHL, n = 84	0.45 (0.17 - 1.16)	0.098	NA
Myeloma, n = 31	0.37 (0.12 - 1.11)	0.077	NA
Treatment per pathology
HL, n = 30	Ref		NA
DLBCL, n = 35	0.36 (0.12 - 1.06)	0.063	NA
Other lymphoma, n = 49	0.52 (0.19 - 1.46)	0.217	NA
Myeloma, n = 31	0.34 (0.12 - 1.11)	0.077	NA
Lymphoma
Ann Arbor stage* I-II, n = 37/97	1.15 (0.49 - 2.73)	0.752	1.37 (1.26 - 1.49)
FLIPI < 2, n = 8/13	0.36 (0.01 - 10.68)	0.509	NA
MIPI < 3, n = 3/6	6.29 × 10⁸ (0 - NA)	0.997	NA
IPI < 3, n = 18/29	0.38 (0.08 - 1.65)	0.202	0.74 (0.52 - 1.06)
Myeloma
ISS index I, n = 16/25	2.89 (0.24 - 67.90)	0.414	NA
PCLI < 0.63 (%), n = 18/24	0.20 (0.01 - 1.58)	0.142	NA
Ratio tumoral/normal plasmocytes < 8.15 , n = 9/27	0.51 (0.09 - 2.57)	0.350	0.76 (0.47 - 1.24)

Table 2. Association Between Parameters Measured at Diagnosis and Cachexia During Treatment

Original data

Bootstrap analysis (1,000 replicates)

OR (95% CI)

Mean OR (95% CI)

*For all lymphomas. CI: confidence interval; CRP: C-reactive protein; DLBCL: diffuse large B-cell lymphoma; FLIPI: follicular lymphoma international prognostic index; IPI: international prognostic index for other lymphoma; ISS: international scoring system for multiple myeloma; HL: Hodgkin lymphoma; MIPI: mantle cell international prognostic index; NHL: non-Hodgkin lymphoma; OR: odds ratio; PCLI: plasma cell labeling index.

Total proteins > 72.5 g/L, n = 54/122

1.62 (0.77 - 3.47)

0.208

1.48 (1.38 - 1.58)

Albumin > 41.3 g/L, n = 43/122

1.21 (0.56 - 2.65)

0.635

1.39 (1.29 - 1.49)

CRP > 54.0 mg/L, n = 16/114

5.94 (1.55 - 39.14)

0.023

8.17 (3.44 - 19.41)

Hemoglobin > 12.0 g/L, n = 90/143

1.39 (0.69 - 2.79)

0.353

1.14 (1.03 - 1.27)

Creatinine > 93.5 µmol/L, n = 26/141

0.30 (0.12 - 0.73)

0.009

0.78 (0.64 - 0.96)

Pathology

HL, n = 30

Ref

NHL, n = 84

0.45 (0.17 - 1.16)

0.098

Myeloma, n = 31

0.37 (0.12 - 1.11)

0.077

Treatment per pathology

HL, n = 30

Ref

DLBCL, n = 35

0.36 (0.12 - 1.06)

0.063

Other lymphoma, n = 49

0.52 (0.19 - 1.46)

0.217

Myeloma, n = 31

0.34 (0.12 - 1.11)

0.077

Lymphoma

Ann Arbor stage* I-II, n = 37/97

1.15 (0.49 - 2.73)

0.752

1.37 (1.26 - 1.49)

FLIPI < 2, n = 8/13

0.36 (0.01 - 10.68)

0.509

MIPI < 3, n = 3/6

6.29 × 10⁸ (0 - NA)

0.997

IPI < 3, n = 18/29

0.38 (0.08 - 1.65)

0.202

0.74 (0.52 - 1.06)

Myeloma

ISS index I, n = 16/25

2.89 (0.24 - 67.90)

0.414

PCLI < 0.63 (%), n = 18/24

0.20 (0.01 - 1.58)

0.142

Ratio tumoral/normal plasmocytes < 8.15 , n = 9/27

0.51 (0.09 - 2.57)

0.350

0.76 (0.47 - 1.24)